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Credentialing for LIBERTY Dental Plan Network Providers

Specific Network Credentialing Qualifications

LIBERTY follows all NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services) and Federal and State regulations during its credentialing process. In order to qualify for participation providers must submit the following documents for Credentialing:

  • Provide a fully completed LIBERTY Dental Plan Credentialing Application to include:
  • Practice name, address, phone and fax numbers
  • TIN and SSN for processing and collecting the required individual background history checks
  • Provide an NPI (Type I) and entities (Type II) billing, as applicable 
  • Education and training information as appropriate to application specialty(ies)
  • Specify if Board Certified and Hospital Privileges, as applicable
  • Complete the work history page for the most recent five (5) years, with no work history gaps
  • Sign and date the Credentialing Attestation, Authorization and Release Forms
  • Submit a current, valid, professional Dental License(s)
  • Submit a current, valid, DEA Certificate or State Controlled Substance certificate, if applicable
  • Submit a current, valid Malpractice Insurance Certificate showing ‘Professional Liability’ coverage with limits of at least $1,000,000 per occurrence and $3,000,000 aggregate
  • If a Specialist, submit a Specialty Certification from the educational facility attended

LIBERTY Dental Plan conducts all verifications, background, malpractice, government sanction checks and a Credentialing Committee review on each network provider prior to approval.  It may take 90 days to complete the credentialing process, however many providers can complete the process in as little as 10 days.

A full review of all LIBERTY contracted dental providers is conducted every three years to maintain current and accurate files, and to ensure the provider is still in accordance with all minimum requirements as required by NCQA, CMS, and Federal and State regulations.

There may be times between credentialing cycles when it is appropriate to add, change or delete a specialty description as represented in the provider directory. Additional education or training documentation verification may be necessary to make this change if it was not verified or requested during the initial credentialing process. There may also be times between credentialing cycles when it is appropriate to request an updated Dental License, DEA License and/or Professional Liability Insurance Certificates in order to maintain credentialing files as required by NCQA, CMS, Federal and State regulations.

The LIBERTY Dental Plan credentialing process is a systematic approach to the collection and verification of a provider’s professional qualifications, and the assessment of whether the provider meets professional competence and conduct criteria relating to professional competence and conduct to be a LIBERTY Dental Plan provider.  The LIBERTY Credentialing process reflects our dedication to investing in our professional development, and our commitment to our members to ensure the highest quality dental network.